Risk and clinical implications of transformation of follicular lymphoma to diffuse large B-cell lymphoma
Risk and clinical implications of transformation of follicular lymphoma to diffuse large B-cell lymphoma
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DOI：
10.1200/jco.2006.09.3260
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发表时间：
2007-06-10
影响因子：
45.3
通讯作者：
Lister, T. Andrew
中科院分区：
文献类型：
--
作者：
Montoto, Silvia;Davies, Andrew John;Lister, T. Andrew
目的探讨滤泡性淋巴瘤(FL)患者转化为弥漫性大B细胞淋巴瘤(DLBCL)的临床意义。中位随访时间为15年，325名患者中有186名患者病情进展，88名患者经活检证实有转归。结果10年后组织学转化(HT)的风险为28%，16.2年后仍未观察到HT。晚期(P=0.02)、高危滤泡性淋巴瘤国际预后指数(FLIPI；P=0.01)和国际预后指数(IPI；P=0.04)评分的患者风险更高。期待治疗(而不是在确诊时开始治疗)也预示着更高的高血压风险(P=0.008)。高龄(P=.005)，低血红蛋白水平(P=.03)，高乳酸脱氢酶(P<；.0001)，以及首次复发时高危FLIPI(P=.01)或IN(P=.003)评分与当时进行的活检诊断为HT有关。中位生存期为1.2年。与未确诊的患者相比，高血压患者的总生存期(P<；.0001)和进展后生存期(P<；.0001)都较短。结论晚期和高危的FLIPI和IN评分与诊断时的高血压风险增加相关。这一事件通过缩短患者的生存时间而强烈影响FL患者的预后。可能有一组患者没有发生高血压。
Purpose To study the clinical significance of transformation to diffuse large B-cell lymphoma (DLBCL) in patients with follicular lymphoma (FL).Patients and Methods From 1972 to 1999, 325 patients were diagnosed with FL at St Bartholomew's Hospital (London, United Kingdom). With a median follow-up of 15 years, progression occurred in 186 patients and biopsy-proven transformation in 88 of the 325. The overall repeat biopsy rate was 70%.Results The risk of histologic transformation (HT) by 10 years was 28%, HT not yet having been observed after 16.2 years. The risk was higher in patients with advanced stage (P = .02), high-risk Follicular Lymphoma International Prognostic Index (FLIPI; P = .01), and International Prognostic index (IPI; P = .04) scores at diagnosis. Expectant management (as opposed to treatment being initiated at diagnosis) also predicted for a higher risk of HT (P = .008). Older age (P = .005), low hemoglobin level (P = .03), high lactate dehydrogenase (P < .0001), and high-risk FLIPI (P = .01) or IN (P = .003) score at the time of first recurrence were associated with the diagnosis of HT in a biopsy performed at that time. The median survival from transformation was 1.2 years. Patients with HT had a shorter overall survival (P < .0001) and a shorter survival from progression (P < .0001) than did those in whom it was not diagnosed.Conclusion Advanced stage and high-risk FLIPI and IN scores at diagnosis correlate with an increased risk of HT. This event strongly influences the outcome of patients with FL by shortening their survival. There may be a subgroup of patients in whom HT does not occur.